Placental
abruption is the early separation of the placenta (afterbirth) from the
wall of the uterus (womb). The placenta is an organ that grows
inside the uterus during pregnancy to provide food and oxygen
to the baby. Separation of the placenta before delivery occurs in about
one in 120 births. It can occur any time after about the
twentieth week of pregnancy, and occurs more often in the
last three months.

Normally
the placenta does not separate from the uterus until right
after the birth of the baby. When placental abruption occurs,
the placenta starts to come away from the uterus before
the baby is born. This can cause serious problems for the
baby and mother.

You
are at a higher risk for placental abruption if you:

Smoke cigarettes

Are 35 years of age or older

Have had more than 4 or 5 children

Are pregnant with twins or triplets

Have high blood pressure

Use cocaine or other illegal drugs

Have diabetes

Have had a previous abruption

Have trauma to the uterus such as a car accident or a fall

Have certain blood clotting disorders

Bag of water breaks early in the pregnancy

The
symptoms of placental abruption may include:

Contractions (tightening of the uterus) that don’t
stop

Severe back or abdominal pain

Tenderness in the abdomen over the uterus

Vaginal bleeding (sometimes)

How
is it diagnosed?

The
doctor or midwife will give you a physical exam, looking
for signs of blood loss. These tests may be done:

Blood tests

Ultrasound scan to look for a blood clot behind the placenta

Fetal monitoring to check the baby’s heart
rate and look for signs of distress in the baby

The
abruption may be described as a Grade 1 (mild), Grade 2
(mild to moderate), or Grade 3 (moderate to severe).

How
is it treated?

This
will depend on many things such as:

How much of the placenta has separated from the uterus

How close the pregnancy is to full term (37 weeks or more)

Your health and whether you have other problems, such
a high blood pressure

The amount of blood you have lost

The baby’s health

If
the separation of the placenta is small, the baby isn’t
in distress, and your condition is stable, you may be able
to go home and continue the pregnancy with frequent checkups. You may be advised to avoid sexual activity and some forms of physical activity.

If you are admitted to the hospital, you will be given intravenous (IV) fluids. A fetal monitor will be used to check the baby for signs of distress. Your blood pressure, pulse, and amount of bleeding will be closely checked. Blood tests will be doneto check your iron level and blood clotting factors.

If
the separation is moderate, the baby is not
in distress and your condition is stable, the doctor may
induce labor and perform a vaginal delivery. If the baby
is in distress or if you are losing a lot of blood, the
doctor will deliver the baby immediately by cesarean section.

There
is no treatment to stop the placenta from separating or
to re-attach it. The baby can survive when even up to one
half of the placenta is separated from the uterus.

What
are the effects?

Sometimes
the separation and bleeding begins and then stops without
treatment. As long as you and the baby are healthy, your
pregnancy can continue with frequent checkups. A mild case
will probably have no long-term effects on your health or
your baby’s health.

A
moderate to severe separation of the placenta may have the
following effects:

A large blood loss may require blood transfusions and
intensive care after delivery for the mother

The baby may be in distress until delivery and may need
to be born prematurely. They may have problems with breathing
and feeding. In severe cases the baby could have permanent
problems or be stillborn.

The
good news is that with quick attention and expert care,
nearly all mothers and their babies survive.

Helping
to prevent placental abruption

Good
prenatal care (beginning in the first thirteen weeks and
continuing with regular visits) and a healthy diet may reduce
the risk of high blood pressure during pregnancy. Prevention
of high blood pressure decreases the risk of abruption.

If
you smoke, decreasing the number of cigarettes and stopping
smoking will decrease your risks of having a placental abruption.

Always use a seat belt in the car to minimize any potential trauma from a car accident. If an accident does occur, or if you have a fall, either call your provider or go to the hospital for further monitoring.

Abruption
caused by the use of cocaine or amphetamines can be prevented if the mother
stops using these drugs.

If
you have had a placental abruption with a previous pregnancy
and are pregnant again, be sure to report this to your care
provider and immediately report any contractions or bleeding
you might experience.

If
you have further questions about placental abruption, contact
your doctor or midwife. This pamphlet is for informational
purposes only, and should not replace the advice of a care
provider.